Professor Gilbert Welch, MD, wrote a very interesting article in the New York Times recently about the current state of preventive medicine and how it pertains to the US presidential campagnes.

Today, Preventive Medicine should really be called early disease detection.  People are encouraged to come in to see the doctor at various ages in order to make sure they don’t have an illness that they are unaware of.  This approach is effective at detecting some diseases before they are out of control, but it does little to prevent disease and it ends up costing us more money.

In contrast, health promotion prevents disease.  The best preventive medicine involves educating patients (the word doctor means teacher) about how to care for their bodies, eat properly, exercise properly, and encouraging them to adopt healthy lifestyle habits and a positive outlook on life.

So next time you hear someone talking about preventive medicine, you may want to clarify: are they talking about disease detection or are they talking about promoting health so that disease is less likely to occur.

At his medical practice at the Sage Clinic in Vancouver, Dr Oughtred emphasizes health promotion, disease prevention and the enhancement of athletic performance.

St John’s Wort Shown shown to be effective for depression

-The herb St John’s Wort has shown to be better than placebo, comparable to pharmaceutical antidepressants in effectiveness, and has less side effects than standard antidepressant medications.  This from a recent Cochrane review that compared 29 scientific studies with over 5,000 patients.

Ginko may offer protection from the damaging effects of Stroke

-The herb Ginko Biloba, well known for its ability to promote vascular health, has been shown to mitigate the brain damage in mice who have had a stroke.  Researches showed the herb to be effective if used both before or after a stroke.  This recently from the journal, Stroke.

Pregnant women may be gaining too much weight

-A recent study published in the Journal of the American Dietetic Association suggests that habitual dieters and overweight women were more likely to put on too much weight during pregancy.  The authors suggested that these women may be looking at pregnancy as an excuse to eat whatever they want, and should be instructed not to increase their caloric intake during the first trimester of pregnancy.

Topical Antioxidants may Prevent Skin Cancer

-In September’s issue of the American Academy of Dermatology, an antioxidant cream containing Vitamin C, E and ferulic acid prevented skin from burning, an established cause of skin cancer.

More Links Between Low Vit D and MS

-The evidence for supplementing with Vit D is becoming overwhelming.  Now the question is, how much should you take?  Your health care provider can do diagnostic tests as well as functional tests to help you choose your best dose.

Acupuncture More Effective than Medications for Hot Flashes

-Dr. Eleanor Walker and researchers of Henry Ford Hospital in Detroit found that acupuncture was just as effective as medications used to treat hot flashes in breast cancer patients, and the effects lasted longer without the negative side effects.

Eating fish can prevent eczema in children

-A recent finding the British Medical Journal states that fish consumption in children before the age of 9 months is associated with less cases of eczema.  Fish, a common aldult allergen, is often avoided at such an early age in infants because it is thought that allergies to fish could be result in later life.  Whatever the reasons, it appears that small amounts of fish before the age of 1 may be a good idea for your infant.

Do doctors have time for empathy?  Does it improve outcomes?

-The answers are yes, and yes.  This was an interesting article in the New York Times written by a medical doctor, reviewing the benefits of taking short periods to express empathy for their patients in their busy schedule.  This article is a reminder the of the importance of the doctor-patient relationship, and the positive effects that it can have for the health of patients.

Health on the Web

-An interesting article in the New York Times that outlines 6 intersting, online health resources.

Cortisol Levels Linked to Antisocial Behavior

-University of Cambridge researchers have been able to show that teenaged boys who lack the normal surge in the stress hormone cortisol, experience more antisocial behaviors.  This is an interesting finding because Naturopathic Physicians have been marginalized over the years by the medical community for its philosophies and treatment strategies around this hormone.  The idea that the adrenal gland (the main producer of cortisol in humans) could be weak in some patients, seemed to be far fetched.  I look forward to more research on Corticol and behavior.

Aerobic exercise may prevent age related changes in the brain

- The research to support the benefits of exercise continues to mount, this time in support of enhanced cognition and executive function in the aging brain.  With all of the positive research findings for exercise, you would think people would become more active, but that is not the case.  Perhaps some of that research should move toward discovering the best methods to get our society more active; telling people that exercise is good for them is clearly not enough.

In the December 2007 issue of Scientific American, Body, there was an article titled, “The Ultimate Blood Test”.  The article was a review of a new blood test called the Biophysical 250, the most comprehensive blood test available to date.  I was intrigued, and eventually I decided to call Biophysical Corp to learn more about the test.  After a few conversations, I was convinced that this was a test that I would be comfortable offering to my patients.

It’s called the Biophysical 250, because it measures 250 things in your blood, all at once.  For those afraid of having blood drawn, you can rest assured that the test requires only 2 tablespoons of blood.  The test covers blood markers for cancer, heart disease, autoimmune disease, infectious disease, nutritional status, hormonal status, inflammation, blood diseases, osteoarthitis, and organ dysfunction.  Biophysical Corp does not advocate testing anything that there is no treatment for, so they don’t test markers for alzheimers for instance.  Biophysical reports that in a trial of 120 clients who received the Biophysical, 27 clients had a moderate health risk, and another 15 had a major health risk.  The Biophysical 250 can help discover problems before they become problems, and there are many markers that wouldn’t normally be tested for until the disease was already apparent.   Some examples are:

• H-pylori (a bacteria associated with stomach ulcers)
• Autoimmune markers (For lupus, scleroderma, or rheumatoid arthritis)
• Insulin (high insulin levels are thought to precede type 2 diabetes)
• Cancer markers (Breast, Prostate, Colon, Pancreas, Liver, Testicular)
• Ferritin (high ferretin can be assymptomatic, and represents high iron stores, which can be harmful to the body over time)
• Thyroid Markers (thyroid disease is common, and can go a long time before being diagnosed)
• Hepatitis markers

The trouble with waiting until you get a disease, is that you stand the risk of not being able to reverse the disease process once it is diagnosed.  Cancer and autoimmune diseases are classic examples of diseases that have much better outcomes if treated earlier.

The Biophysical 250 does not replace a comprehensive annual health screen with your physician, but for those who can afford it, it can be a great, low risk adjuct to a comprehensive medical assessement for the patient that wants to know more about their existing state of health.

To learn more about the test, visit: http://www.biophysicalcorp.com/ .  The company has also come up with an abreviated version of the test that is priced more competitively, and still screens for several of the same markers.

Dr Oughtred has moved his clinical practice from it’s old location to it’s new home at Sage Clinic.

Located in Yaletown in the heart of Vancouver, BC, Sage Clinic is a natural healthcare clinic with naturopathic medicine and acupuncture.  The clinic is located at 487 Davie Street, across from Choices Market at the corner of Richards and Davie.

He is seeing patients there on Mondays and Wednesdays for any of his clinic services including the new Biophysical 250, health assessments, diet management, Chinese medicine, counseling, and joint stabilization therapy.

Because meats and vegetables are not normally consumed at breakfasts, it can be difficult to stick to your diet at breakfast.

• Foods to avoid at breakfast:

• Breads

• Hash browns and other Potatoes

• Cereals (especially ones with sugars added)

• Muffins & Croissants

• Jams & Butter

• Yoghurt (especially ones with sugar added)

• Milk & Fruit Juices

The following are examples of typical breakfast foods that are allowable

Omelettes

• Ask for greens or sliced tomatoes instead of potatoes or toast

• Add vegetables: Onions, zucchini, and other green veggies are best

• Hold the cheese, or use cheese sparingly

• Egg white omelettes are not necessary, but they are certainly lower calorie choices

• Frittata

• Eggs and Style

• Cottage Cheese

• Natural, unsweetened soy milk

• Tofu

• Sliced Tomato or mixed greens can be an easy side to your eggs

• Nuts and seeds (whole or spread versions)

• No sweetened peanut butter

If you have no other alternatives:

• Unsweetened oatmeal

• You can flavour with nuts, seeds or spices

• If you need milk, then try natural soy milk or non-fat natural yoghurt

• Apples, pears, or grapefruits are okay

• Protein smoothies are okay, but most restaurant made smoothies are too sweet

Choose between the following items:

• Sashimi (not too much tuna, choose salmon more often)

• All seafood is okay

• You can usually add an order of mixed vegetables

• Most soups and salads are ok

• Miso Soup

• Gomaae salad

• All Teriyaki is okay, except tofu

• Order no rice, extra veggies

• Chicken (don’t eat skins)

• Seafood is best

Avoid:

• Rice

• Dumplings

• Tofu (unless it is not deep fried)

• All tempura items

There are many salad bars available in Vancouver. For now, they are listed in their specific regions within the Weight Loss Restaurants category.

Dressings:

Bring your own or keep your own at work.

You never know what you are going to get with dressings, and many of them may have undesirable contents such as sugars, artificial flavours or colours, trans fats, or saturated fats. They also may lack unsaturated fats that your body needs to function properly.

When choosing dressings, simple is usually best. Contents like extra virgin olive oil, and other expeller pressed vegetable oils such as sesame, sunflower, borage, hemp, pumpkin or flax are best. Vinegars, fruits, and spices are all welcome ingredients. Organic ingredients are good, and they usually show that the manufacturer is making an effort to provide a healthy product.

Avoid all cream based dressings. Some creamy looking dressings can actually be okay, but you have to read the label carefully to make sure they did not use fatty animal products.

Avoid additives in your dressings that you don’t need.

Examples of additives you should try to avoid are:

• Sugar

• Trans-fats and hydrogenated vegetable oils

• Bromide or Bromine

• Sulfates and Sulfites/ Nitrates and Nitrites

• MSG

• BHA, BHT, and other contents that start with ‘Benz’

• Artificial colors, flavors, or sweeteners

• Hydrolyzed Vegetable Protein (HVP)

Choose the following items at your salad bar:

• Eggs (For faster results, remove the egg yolks)

• Fish (Most salad bars have tuna. Don’t have tuna more than twice per week, and don’t the ones that are already mixed with mayonnaise)

• All green leafy vegetables: Spinach, Lettuce (all), Kale, Mixed greens, Arugula

• Zucchini

• Onion

• Mushrooms

• Celery

• Cabbage

• Cauliflower

• Broccoli

• Water chestnuts

• Cucumbers

• Sprouts

• Brussel sprouts

• Pickles

• Radishes

• Parsley

• Artichoke

Higher carbohydrate vegetables (moderate quantities only):

• Tomato

• Carrot

• Peppers (all types)

• Snow peas and snap peas

• Green beans

Nuts and Seeds (use sparingly):

• Good Choices:

• Nuts – Almonds, walnuts, pecans, hazelnuts, and pistachios.

• Seeds – Pumpkin, sunflower, flax (must be ground in blender or processor)

• Soy nuts

• Less optimal choices – Macadamia, brazil, cashew, and pine.

• Cottage Cheese

• Feta Cheese (use sparingly)

• Mozzarella (use sparingly)

• Avocado

• Soybeans

• Tofu

During my 7 years of competition with the Canadian alpine ski team, I experienced several injuries, the most frustrating of which were the insidious injuries that seemed to appear out of nowhere. These injuries could last for months to years, and usually required multiple treatments to heal. Because one treatment alone was rarely effective, I began to think that there was more than one cause for these problems. It was for this reason that I decided to become an integrated health care professional, utilizing expertise from several different areas to help people experience better health.

Many chronic problems have more than one cause: type 2 diabetes, heart disease, autoimmune disease, asthma, headaches, overuse injuries, back and neck pain, irritable bowel, PMS, and psoriasis, are all examples of problems that have more than one cause or contributing factor. Common sense dictates that the assessment and treatment of such problems should be multifactoral. For example, an integrative assessment of the patient with chronic headaches would consider the following factors:

• Inactivity or obesity

• Overweight individuals that don’t exercise experience more health problems, including headaches

• Blood pressure

• High blood pressure or sudden changes in blood pressure can increase your likelihood of head pain

• Hormonal imbalance

• Migraines occur more in women, and they will often notice their pain fluctuates with menses

• Blood sugar imbalance

• Fluctuations in blood sugar can lead to the vascular constriction or dilation that is often associated with headaches

• Stress and cognitive influences

• Those who experience anxiety or depression, experience more headaches

• Neck problems

• The upper two vertebrae in your neck can cause an increase in head pain when they are dysfunctional

• TMJ problems or dental problems

• Food sensitivities

• Environmental sensitivities

• Poor posture and work position

• Poor vision or eye problems

• Infection or cancer

• Drug interactions

• Inflammatory disease

• Past trauma/ accidents

A multifactoral assessment allows the health provider to look at your health from a ‘bird’s eye view’, and focus treatments on the areas of your health that might contribute to your pain. Treatments could include physical therapies, supplements, therapeutic exercise, specific herbs, a special diet, or cognitive behaviour therapies. However, without an integrated assessment of your health, your treatment may be one sided, and may fail to address weaknesses in your complete health picture. It is for this reason that I recommend an integrated approach for your chronic problems, the prevention of disease, and for the pursuit of your optimum health status.

Ryan Oughtred

Injury to the lower back is one of the more common injuries incurred by the alpine skier. Waiting for back problems to happen before doing anything about them is probably a bad idea; the discs and bones of the spine generally only have nerves on their outermost portions, which means that damage to the inner portions of the vertebrae and discs can occur without experiencing any pain at all. The spine can degenerate ‘from the inside out’ for many years without any warning signals, and by the time an athlete is 26 years old-in the peak of a career-the spine can have significant amounts of permanent wear-and-tear. Here are the 5 most important preventive measures I think athletes and support staff can take to prevent back problems:

Build progressions in training schedules:

1. The risky forces for the spine are flexion, rotation, compression, and sheer; all of which are involved in skiing. Because avoidance of these risky forces is not possible, the athlete must be exposed to them gradually over time. Both on-snow and dry-land training should gradually involve progressions in both volume and intensity of activities that involve bending forward, twisting, weight lifting, and eccentric loading.

2. The adolescent spine may be especially vulnerable because the growth plates of the vertebrae are softer than in an adult, making them more prone to injury from compression and sheer forces.

Sit less, and never lift heavy after sitting:

1. Any time the spine is flexed forward for a period of time, such as with sitting, a phenomenon called ‘creep’ occurs in the tissues. The tissues are melded toward a shape that is different than normal. Heavy lifting or other compressive activity (such as ski racing) should be avoided immediately following a prolonged period of sitting or forward bending.

2. To combat the effects of creep from sitting on planes, in cars, or on chairlifts, athletes can perform extension exercises like McKenzie press-ups or other extension movements any time they have been prolonged to excess flexion.

3. When traveling – I would never allow athletes to lift heavy bags immediately after riding in a van or on a plane for hours. Stand up, walk around, and maybe bend the spine back a couple of times before lifting anything heavy.

4. When riding the chair lift – athletes should take time after every chair lift ride to stand up, bend back a little, and warm up before diving into another race run. While riding the chair, a relaxed upright posture is probably best.

Compress and twist the spine judiciously:

1. Twisting while you lift heavy weight doubles the load through the back. Athletes should be taught to never twist while they are lifting, unless it is an exercise specifically designed to prepare them for skiing.

2. Discourage athletes from packing heavy bags, and encourage them to share the work of lifting with other people.

Keep your spine neutral and stable:

We know that stability of the spine will prevent injury, but applying that to practice is not a simple task.

1. Maintain a neutral spine as much as possible when training, especially when lifting heavy weights or twisting.

2. Focus on endurance of the spinal related muscles, not just strength.

3. Integrate components of instability, unpredictability and precision into dry land training.

4. Full body exercises are probably better than isolated muscular activities. Even if the athlete feels like the exercise is too easy, it is still doing something for them.

5. Make sure athletes can breathe evenly throughout entire exercises.

6. Encouraging the athlete to lightly draw in their tummy, or ‘feel like they are stopping a pee’ while working out, might add to their spinal stability. Train everything. All the muscles of the core probably contribute to injury prevention in some way, as does the lower body and upper body. Search for balance, find weaknesses and eliminate them.

Proper biomechanics-the earlier better:

1. Taking the time to consult with someone who understands normal spinal mechanics and how to assess it could be a valuable investment.

2. If one area of the spine is not moving well, other spinal regions may be forced to work too hard, or in an unbalanced fashion. Detecting these kinds of imbalances early in a career may prevent future injury or even enhance athletic performance.

The field of low back problems is a difficult area. I have done my best to consider some of the evidence so far, and apply it to the ski racing athlete. I hope it was helpful!

Ryan Oughtred

More to read:

• Panjabi MM. The stabilizing system of the spine. Part 1. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 1992; 5(4):383-9

• Richardson CA, Jull GA, Hodges PW, Hides JA. Therapeutic exercise for spinal segmental stabilization in LBP: scientific basis and clinical approach, Edinburgh: Churchill Livingstone; 1999

• McGill S. Low back disorders: evidence based prevention and rehabilitation, Champaign, IL: Human Kinetics Publishers, Inc.; 2002

• N. Bogduk, B. McGuirk. Medical Management of Acute and Chronic Low Back Pain. An Evidence Based Approach. Elsevier Science. 2002